Easier Access to After-Hours Care Linked to Less Emergency Department Use

WASHINGTON, DCPatients with problems reaching their primary care practice after hours are more likely to report ending up in the emergency department and going without needed medical care, according to a study by the Center for Studying Health System Change (HSC) published today as a Web First by Health Affairs.

Funded by the National Institute for Health Care Reform, the study is the first to use a nationally representative sample to describe the U.S. population’s access to after-hours care via people’s usual primary care practice. In the study, HSC Senior Fellow Ann S. O’Malley, M.D., M.P.H., analyzed data from HSC’s 2010 Health Tracking Household Survey related to the 9,577 respondents who reported having a usual source of care.

The study, detailed in a Health Affairs’ article titled “After-Hours Access to Primary Care Practices Linked with Lower Emergency Department Use and Less Unmet Medical Need,” found that of the 9,577 people with a usual source of care, 1,470 reported trying to contact their primary care practice after hours in the previous 12 months. Of the 1,470 people who tried to contact their practice, 20.8 percent reported it was “very difficult” or “somewhat difficult” to reach a clinician after hours.

After adjusting for age, health status and other factors, the study found that people reporting more difficulty contacting their primary care practice after hours were significantly more likely to report an emergency department visit or going without needed medical care, compared to those who described their after-hours access experience as “not at all difficult” or “not too difficult.”

In particular, those who reported more difficulty accessing after-hours care had higher rates of emergency department use37.7 percent vs. 30.4 percent for those with less difficultyand higher rates of unmet medical need13.7 percent vs. 6.1 percent.

“The findings indicate that increased support for primary care practices to arrange for accessible after-hours carewhether by phone, email or in personhas the potential to reduce rates of emergency department use and unmet medical needs,” O’Malley said.

Other key study findings include:

Among people with a usual source of primary care, 40.2 percent reported that their practice offered extended hours, such as at night or on weekends.

Children, people in better health, those with private insurance and people using a practice that offers after-hours visits were all less likely to experience difficulty in accessing after-hours care, even after controlling for other factors.

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The Center for Studying Health System Change is a nonpartisan policy research
organization committed to providing objective and timely research on the nations
changing health system to help inform policy makers and contribute to better
health care policy. HSC, based in Washington, D.C., is affiliated with Mathematica Policy Research.